위식도 역류와 위식도 역류 병, Gastroesophageal reflux(GER) and gastroesophageal reflux disease (GERD)

• 생리적 위식도 역류로 신생아들의 85%는 생후 1주까지 먹은 젖이나 인공영양을 가끔 넘길 수 있다. 
• 신생아들의 10% 정도가 젖을 넘길 수 있다. 
• 아무 치료를 받지 않아도 생후 2세까지 그런 생리적 위 식도 역류의 증상의 60%는 자연히 없어지고 나머지는 4세까지 계속 될 수 있다.
• 경미한 생리적 위식도 역류가 있으면 먹은 젖이나 인공영양을 넘기거나 경미하게 구토할 수 있다. 
• 병적 위식도 역류로 인해 위 속에 있는 위 내 내용물이 위 속에서 식도 속으로 역류돼서 여러 가지 증상 징후가 나이에 따라서 다르게 나타날 수 있다.

• • 신경이 예민하고 음식물 먹기를 싫어하고 재발성 복통, 체중이 증가되지 않고 연하곤란 등이 생길 수 있고 재발성 기능적 역류, 구토, 오목가슴 쓰림 등의 증상 징후가 생길 수 있다.
  • 식도염, 기관지 천식, 무호흡증, 서맥(심박이 비정상적으로 서서히 뛰고), 또는 재발성 폐렴이 생길 수 있다. 

• 지속성 천식이 있는 비 아토피성 소아들의 3분의 2에서 위식도 역류 병(GERD)이 있고 위식도 역류 병이 잘 치료되어야 천식도 잘 치료된다(출처;Pediatrics News December 2008). 
• 구기, 구토, 빈혈, 토혈, 위장출혈, 야간성 기침, 목쉼, 복통, 짜증, 식욕 감퇴, 구취, 고약한 입맛, 입안에서 신 냄새, 사경 등의 증상 징후가 생길 수 있고 드물게는 앞가슴이 뻐근하게 아플 수 있다. 소아 성장 중지증도 생길 수 있다. 
• 자다가 깨기도 한다(출처:American Academy of Pediatrics, Guid to Your Child’s Sleeps). 
• 등을 활같이 꾸부리고 목을 이상한 위치를 취하기도 하고 사경이 생길 수 있다. 

Gastroesophageal reflux (GER) and gastroesophageal reflux disease (GERD)

 

Causes of gastroesophageal reflux and gastroesophageal reflux disease

 

When gastroesophageal reflux is present

◯There is a chest in the garden. The gate is wide open. Source: Encyclopedia of Pediatric and Family Nursing and Galaxo Wellcome

When gastroesophageal reflux is rare

Gastroesophageal mucosa borderline,

◯There is a heart within the circle. The heart is barely open and the stomach contents are refluxing very little into the esophagus. Source: Encyclopedia of Pediatric and Family Nursing and Galaxo Wellcome

• Gastroesophageal reflux (GER) and gastroesophageal reflux disease (GERD) usually result from impaired esophageal motility. See when passing on breast milk or artificial nutrition.

• There are two types of gastroesophageal reflux: physiological gastroesophageal reflux, which commonly occurs in infants, and pathological gastroesophageal reflux, which occurs pathologically.

• The cardiac sphincter between the stomach and the esophagus

o weak o When tension is low, o When, for any reason, the intragastric pressure or intra-abdominal pressure rises above normal,

o When food or gastric juices in the stomach go down abnormally slowly into the duodenum;

o Other causes may cause the heart to open and the contents of the stomach may reflux from the stomach into the esophagus (tube). In this case, it is called gastroesophageal reflux and its contents can come out into the pharyngeal cavity or into the oral cavity. This case is called gastroesophageal reflux disease. However, there are many times when the two cases cannot be clearly distinguished.

• When this phenomenon is mild and physiological, it is called physiological gastroesophageal reflux disease, and when it is severe and causes symptoms and complications, it is called pathological gastroesophageal reflux disease or gastroesophageal reflux disease.

• Gastroesophageal reflux may cause gastric contents to rise through the heart into the oral cavity and pharyngeal cavity. In this case, functional reflux is called functional reflux, and functional reflux in which gastric contents pass through the heart and only into the esophagus is called occult reflux.

• Functional regurgitation is very common before the first stone.

• Gastroesophageal reflux (GER) occurs in about 40% of children at 3–4 months of age and less than 5% at 13–14 months of age.

• Gastroesophageal reflux disease (GERD) is reported to occur in 1.8 to 22% of children aged 3 to 18 years.

 

Table. Frequency of gastroesophageal reflux 표. 위식도 역류의 빈도

Source – Mission possible: taking control GERD

Symptoms of gastroesophageal reflux disease

Gastroesophageal reflux Copyright ⓒ 2012 John Sangwon Lee, MD., FAAP

• With physiological gastroesophageal reflux, 85% of newborns can occasionally skip milk or artificial nutrition by the first week of life.

• About 10% of newborns can breastfeed.

• Even without treatment, 60% of the symptoms of physiological gastroesophageal reflux spontaneously resolve by the age of 2 years, and the remainder may persist until age 4 years of age.

• Mild physiological gastroesophageal reflux may result in overdose or mild vomiting.

• Due to pathological gastroesophageal reflux, the contents of the stomach in the stomach are refluxed from the stomach into the esophagus, and various symptoms and signs may appear differently depending on the age.

• o Sensitive nerves, aversion to food, recurrent abdominal pain, weight loss, and difficulty swallowing may occur, and symptoms such as recurrent functional reflux, vomiting, and heartburn may occur.

o Esophagitis, bronchial asthma, apnea, bradycardia (an abnormally slow heartbeat), or recurrent pneumonia may occur.

• Two-thirds of non-atopic children with persistent asthma have gastroesophageal reflux disease (GERD), and when gastroesophageal reflux disease is well treated, asthma is also well treated (source; Pediatrics News December 2008).

• Symptoms such as goji, vomiting, anemia, hematemesis, gastrointestinal bleeding, nocturnal cough, hoarseness, abdominal pain, irritability, loss of appetite, bad breath, bad taste, sour smell from the mouth, torticollis may occur, and in rare cases, chest pain. can be sick Stagnation of growth in children may also occur.

• Waking up while sleeping (Source: American Academy of Pediatrics, Guid to Your Child’s Sleeps).

• Arching your back, arching your neck in an odd position, and causing torticollis.

Diagnosis of gastroesophageal reflux and gastroesophageal reflux disease

• This disease can be diagnosed by synthesizing the medical history, symptom signs, and examination findings.

• As needed, gastroesophageal contrast X-ray examination while swallowing barium and upper and lower gastrointestinal contrast X-ray examination, gastroesophageal scintillation examination, gastroesophageal ultrasonography, esophageal motility examination, intraesophageal 24 It is sometimes diagnosed by a time acidity (pH) test, esophageal gastroscopy, and esophageal biopsy.

Differential diagnosis of gastroesophageal reflux disease and gastroesophageal reflux disease

• Differential diagnosis is made for infectious esophagitis, eosinophilic esophagitis, infant colic, heart disease, chronic otitis media, central nervous system disease, metabolic abnormality, protein allergy, kidney disease, and love deficiency syndrome.

Treatment of gastroesophageal reflux and gastroesophageal reflux disease

• Mild gastroesophageal reflux is sometimes treated by eating moderately small amounts of semi-solid food frequently, burping well after eating, raising the head and upper body 30 degrees higher than the lower body, and laying the stomach on the floor.

• Sometimes treated with one of the following histamine receptor antagonists (H2RAs/H2 blockers);

o Cimetidine (Tagamet), o Zantac (Ranitidine Hcl),

o Pepcid (Famotidine),

o It is sometimes treated with histamine receptor antagonists (H2RAs/H2 blockers) such as Nizatadine (Axid),

• It can be treated with one of the following PPIs (Proton pump inhibitors).

o Reglan (Metoclopramide),

o Domperidone (Motilium/Motillium/Motinorm Costi/Nomit). o Nexium (Esomeprazole Magnesium),

o Prilosec (Omeprazole),

o Lanzoprazole (Prevacid), etc.

• Severe gastroesophageal reflux disease can be treated surgically if active medical treatment is not effective for about 6 weeks.

• Two-thirds of non-atopic children with persistent asthma have gastroesophageal reflux disease (GERD) and need to treat gastroesophageal reflux disease with proton pump inhibitors and prokinetic agents. As a result of treatment with surgery and asthma medication, persistent asthma was successfully cured. Sources and References

• Pediatrics News. December 2008. P8.

• MD Ney Guide, May 2006

• And many more Complications of gastroesophageal reflux disease

• bronchitis;

• laryngitis;

• Sinusitis;

• recurrent otitis media;

• tooth erosion;

• Erosive esophagitis

• Esophageal stricture

• Barrett’s esophagus

• Esophageal cancer

• etc

The following is an example of Q&A for health counseling for children and adolescents on the Internet regarding “Gastroesophageal Reflux Disease 100 Questions and Answers”.

Q&A. Gastroesophageal reflux disease

Q. What is the difference between gastroesophageal reflux disease and gastroesophageal reflux disease?

A. Physiological gastroesophageal reflux disease (GER) or physiological gastroesophageal reflux disease (GER) or physiological gastroesophageal reflux disease (GERD), which newborns and infants pass after eating breast milk, artificial nutrition, or food, and occasionally vomit, but grows and develops normally and does not cause complications such as bronchial asthma It is said However, gastroesophageal reflux disease (GERD), which accompanies complications such as malnutrition, respiratory abnormalities and symptoms of respiratory abnormalities, esophagitis, and growth and developmental abnormalities, is called gastroesophageal reflux disease (GERD).

This gastroesophageal reflux disease is pathological.

Q. How common is gastroesophageal reflux?

A. 50% of 2-month-old infants pass breast milk or artificial nutrition at least twice a day due to gastroesophageal reflux, and 15% of 7-month-old infants pass breast milk or artificial nutrition due to gastroesophageal reflux, and 15-month-old infants 1% pass through their food due to gastroesophageal reflux.

Q. How does gastroesophageal reflux occur?

A. The part where the lower part of the esophagus connects to the stomach is called the pylorus. Whether full-term or premature newborns, it is common for the pyloric sphincter in the lower esophagus to be normally tense after feeding with breast milk or artificial nutrition, so that the pylorus is closed so that gastric contents do not regurgitate into the esophagus. However, sometimes the cardiac sphincter can relax for a while. In this case, gastric contents may reflux into the esophagus. When an infant or toddler is laid on their back on the floor or when a newborn or infant before 6 months of age is placed on a baby’s chair, when the contents of the stomach are pushed into the lower part of the esophagus, the tension of the cardiac sphincter in the lower part of the esophagus may be relaxed. Reflux may occur. Also, when intra-abdominal pressure rises temporarily due to coughing or other reasons, when the pyloric sphincter in the lower esophagus does not close properly, the pyloric sphincter in the lower esophagus opens and gastroesophageal reflux may occur.

Q. What other diseases should be differentiated from gastroesophageal reflux disease? A. Diseases caused by abnormal metabolism, food intolerance, and congenital esophageal and gastrointestinal obstruction.

Q. What are the main symptoms of gastroesophageal reflux disease?

A. Obstructive apnea, hypersensitivity, nocturnal cough, wheezing, bronchial asthma, recurrent pneumonia, growth retardation, etc.

Q. Is esophageal acidity test of significant value in diagnosing gastroesophageal reflux? A. Of little value in infants with gastroesophageal reflux.

Q. What is the general course of gastroesophageal reflux?

A. The symptoms of gastroesophageal reflux are most severe at 1–4 months of age, 55% spontaneously resolve at 10 months of age, and 80% spontaneously resolve at 18 months of age. From then on, children and adults can sometimes come and go, then come and go.

Q. What are the most common symptomatic signs of gastroesophageal reflux?

A. It is a symptom that passes after eating breast milk or food. When vomiting violently like a fountain, gastroesophageal obstruction, small intestine obstruction, or milk protein allergy should be suspected.

Q. Can gastroesophageal reflux cause esophagitis?

A. Gastroesophageal reflux can cause esophagitis, which can make infants cry, become irritable and irritable.

Q. What symptoms can occur in the upper respiratory tract due to gastroesophageal reflux?

A. Blockage of the pharynx or larynx in infants and young children may result in obstructive apnea, and wheezing or stenosis may occur. After infancy, gastroesophageal reflux may cause hoarseness and convulsive croup symptoms in children.

Q. What symptoms may occur in the lower respiratory tract due to gastroesophageal reflux?

A. Gastroesophageal reflux can cause bronchial asthma attacks. Asthma can occur in 50% of children with gastroesophageal reflux. In particular, gastroesophageal reflux disease can cause asthma while coughing at night.

Q. Can gastroesophageal reflux cause neurological symptoms?

A. Gastroesophageal reflux may cause neurological symptoms with paroxysmal torticollis and ankylosing hernias. This condition is called Sandifer syndrome.

Q. What is the relationship between gastroesophageal reflux disease and food allergy? A. Among children with gastroesophageal reflux disease, symptoms of gastroesophageal reflux disease and symptoms of food protein allergy may occur together.

Q. Complications from long-term gastroesophageal reflux disease?

A. About 10% of children with gastroesophageal reflux disease can develop esophagitis, esophageal stenosis, and Barrett’s esophagus.

Q. How do you treat b-infants with gastroesophageal reflux, but they are large and asymptomatic?

A. Eat small amounts of semi-solid foods more often and properly, burp well, and it will heal naturally over time.

Q. How are infants with symptomatic gastroesophageal reflux treated?

A. Feed semi-solid foods more frequently, treat with prokinetics and treat with antacids. Q. How is severe gastroesophageal reflux disease treated?

A. Actively try medical treatment, and if the treatment is not effective, surgical treatment is performed. It can also be treated with metaclopromide or cisapride.

Q. What medications are used to treat gastroesophageal reflux in symptomatic infants? A. Short-term treatment with antacids and Ranitidine.

The following is an example of Internet pediatric health counseling Q&A regarding “Gastroesophageal reflux, bubbles in the mouth of a child.”

Q&A. Gastroesophageal reflux, bubbles in the mouth of the child.

Q. My baby is 40 days old. It seems that saliva is often seen around the mouth, but if you look closely, there is foam mixed in the saliva, so please inquire. Always bubbling with bubbles in your mouth. I often breastfeed, but after uploading, there are more bubbles. I tend to upload it after a while after eating, so there are a lot of times when milk comes out. It seems to come up from the stomach as it digests. It’s hard after uploading.

A. Romi Good morning. Thanks for asking a good question. The more detailed information such as the child’s age, gender, past medical history, family history, examination findings, and clinical examination, the better we can give you an answer, but we will give you an answer based on the information you have given us. When you breathe through your mouth (when you breathe through your mouth) instead of breathing through your nose, your mouth may bubble more. Find out if there are any abnormalities in the nasal airways or posterior nostrils

And find out if you’re vomiting with gastroesophageal reflux If the problem still persists or if you are concerned, please consult a pediatrician and discuss the problem.WWW.DRLEEPEDIATRICS.COM- Please refer to Volume 3 Newborns, Infants, School-age Children, Growth and Development of Adolescents, Gastroesophageal Reflux, etc. If you have any more questions, please feel free to contact us again. Thank you for visiting. Lee Sang-won.